Population Health: The Call to Community

Population health is the brick and mortar foundation for much of what is truly new in US health reform: expanding healthy behaviors on a community-wide basis; around broadly defined, well-distributed measures of outcomes; in places beyond the institutional setting where care is actually delivered. For big Pharma, it represents yet another escalation in expectations. With the principles of population health firmly embedded in the Obama Administration's Affordable Care Act, drugs now need to do more than simply treat disease. Instead, they must perform a more holistic function in raising the quality of medical interventions, helping hospitals to save money, and keeping well people healthy while preventing sick people from regressing. The problem pharma faces is the lack of a policy consensus on what is population health: how can you execute against something you can't define?

Photo credit: Ted Grudzinski

To shed light on this new movement in health care, Pharm Exec met last month with one of the leading advocates of population health, Dr. David Nash, founding Dean of the Jefferson Medical University School of Population Health in Philadelphia. Nash, like the function he supports, is a practiced multi-disciplinarian. He is a board-certified internist MD; member of the boards of directors of Humana and Endo Health Solutions; chair of the technical advisory group of Pennsylvania's Healthcare Cost Containment Council; and editor of four major peer-review journals. Despite these heady credentials, Nash touts a simple message: to help Americans live longer and better, providers must engage around the patient's 99 per cent – not the one per cent when he/she is "in" the health system.

PE: The School you founded here at Jefferson University is centered on the concept of population health. Can you define population health and explain how it relates to biopharmaceuticals?

Nash: In a word, population health is a management tool designed to acknowledge and respond to the transformations taking place in our health system. It is a systematic approach to coordinating the preventive and chronic care needs of patients: to efficiently manage risk, promote full transparency of information, lower costs and improve health outcomes. We do this through active program interventions based on strong patient data analysis and the cultivation of close ties with community and social service organizations, professional groups – especially primary care providers – as well as hospitals and other institutions directly responsible for care, in both the acute and ambulatory settings. I believe population health management ranks as a true disruptive innovation; we are not defending "business as usual."

Jefferson University, which houses the School of Population Health launched in 2008 and where I currently serve as Dean, is a living illustration of this focused, integrated approach. There are 141 medical schools in the US, but few of them bear any resemblance to Jefferson. Jefferson is a graduate-level health sciences university, with six schools each representing the key stakeholders in the health care system – biologic science, medicine, nursing, pharmacy, allied health professions, and population health – all arrayed around one of the country's largest urban teaching hospitals, a major academic center in its own right.

PE: There appears to be an intimate link between population health and the broader social and economic environment in which health services are financed and delivered. This connection has often been ignored or downplayed by health researchers – but if we are moving toward an incentive system that rewards overall outcomes, isn't it time to shift the discussion on reform back toward the big picture?

Nash: Precisely. There is unassailable evidence that almost all of the factors that determine healthy well-being are social in origin: the operative estimate is 85 per cent. These factors include socio-economic status, where you live, family background, gender and education. I would also add access to preventive health services such as nutrition, screening for basic diseases, reproductive counseling and vaccinations. This 85 per cent figure renders a sobering judgment about the efficacy of the US health system. Practically, it means only 15 per cent of individual well-being is attributable to the pharmaceutical industry and the complex network of academic medical centers, specialist physician practices and 5,000 community-based hospitals that deliver acute care services for millions of patients. The cost is staggeringly disproportionate: nearly 20 per cent of US GDP is spent on that 15 per cent contribution to keeping people well.

How do we population health advocates respond to this statistic? We call a time out. Our message is "stop, think and find a better way to allocate resources and obtain more value for the money we spend on health services."